This is a theoretical study of intersexuality and of its medical and social implications. My interest of inquiry includes both exploring, describing and explaining. One could say that this study is a form of qualitative analysis of contents. The aim of the study is to fill a gap and to raise awareness of the notion intersex. The conclusions show that social models of explanation to today’s paradigm of intervention are valid.

京都大学 / 新制・課程博士 / 博士(人間・環境学) / 甲第24686号 / 人博第1059号 / 新制||人||248(附属図書館) / 2022||人博||1059(吉田南総合図書館) / 京都大学大学院人間・環境学研究科共生人間学専攻 / (主査)准教授 PETERSON Mark, 准教授 中森 誉之, 教授 勝又 直也, 教授 Hawkinson Eric Charles / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DFAM

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The treatment of eating disorders (EDs) presents many challenges. Therapists' reactions towards clients (countertransference) may further complicate treatment. Countertransference may be partially due to the therapist's own vulnerabilities. Due to the personal connection to the work, countertransference towards ED clients may be pronounced among therapists with eating disorder lived experience (EDLE). Previous research indicates that 25-50% of ED therapists have EDLE; yet, minimal research examines how therapists negotiate their experiences while treating ED clients. The existing literature largely operates from the assumption that EDLE is a liability. While therapists with EDLE have some distinct challenges, therapists with EDLE may also have a unique perspective to offer the ED profession. The present study sought to understand how therapists with EDLE use their EDLE as a resource in their clinical work with ED clients. The study was guided by the theoretical frameworks of social constructivism and symbolic interactionism, as well as the person-of-the-therapist clinical training philosophy. Using constructivist grounded theory methodology, semi-structured interviews (Mtime = 89 minutes) were conducted with 22 therapists with EDLE, who work with ED clients. Participants explored how they use and manage their EDLE during key tasks of treatment with their ED clients. Results revealed that therapists engaged in two, interconnected constellations of processes (systems) in order to use and manage their EDLE in clinical practice. The first system (The Central System) helps therapists transform their personal experiences into clinical guidance that they can use to inform their work. The second system (The Checks and Balances System) helps the therapist find a balance between connecting with the client, while also allowing for differences of experiences to emerge. Lastly, personal processes (personal meaning making, values surrounding authenticity, and stigma surrounding EDLE), existing outside of these systems, were also found to impact the ways in which therapists use and manage themselves. Findings have implications for the EDLE literature, by providing novel ways therapists can use their EDLE. Findings also have implications for the POTT framework by exploring how POTT can be adapted for therapists who share lived experiences with their clients. A POTT-EDLE is proposed for training therapists with EDLE. / Doctor of Philosophy / The treatment of eating disorders (EDs) presents many challenges (e.g., frequent comorbidity, high rates of relapse, and the life-threatening nature of the disorder). Therapists' reactions towards clients (countertransference) may further complicate treatment. Countertransference (e.g., worry, frustration, hopelessness) may be partially due to the therapist's own unresolved issues and vulnerabilities. Due to the personal and professional connections to the work, countertransference towards ED clients may be particularly pronounced among therapists with eating disorder lived experience (EDLE). Previous research indicates that 25-50% of ED therapists have EDLE; yet, minimal research examines how therapists use and manage their experiences while treating ED clients. The existing literature largely operates from the assumption that EDLE is a liability and therapists with EDLE are working from a deficit. While therapists with EDLE have some distinct challenges, therapists with EDLE may also have a unique perspective to offer the ED profession. The study sought to understand how therapists with EDLE use their EDLE as a resource in their clinical work with ED clients. Interviews were conducted with 22 therapists with EDLE who work with ED clients. Results revealed that therapists engaged in two systems in order to use and manage their EDLE in clinical practice. The first system (The Central System) helps therapists transform their personal experiences into clinical guidance that they can use to inform their work. The second system (The Checks and Balances System) helps the therapist find a balance between connecting with the client, while also allowing for differences of experiences to emerge. The Central System and The Checks and Balances System work in tandem in order for the therapist to both use and manage their EDLE. Results describe the multiple processes informing these systems. Lastly, personal processes (personal meaning making, values surrounding authenticity, and stigma surrounding EDLE), existing outside of these systems, were also found to impact the ways in which therapists use and manage themselves. Findings have clinical and training implications for how therapists with EDLE can use and manage their EDLE to inform their clinical work with ED clients.

Those living without a diagnosis reside in an invisible margin of health and family research. The purpose of this study was to explore illness uncertainty as experienced by women and their families in the United States. I examined illness uncertainty through a feminist ecological interactionist (FEI) approach with three core constructs: interaction, agency, and context. I conducted narrative-focused, semi-structured interviews with 15 women (aged 25-46) and 11 family members (aged 22 to 62) identified by each woman and completed a constant comparative grounded theory analysis. The findings revealed women's lived experiences with symptoms and social support, interactions with the medical system, and agency in the context of such uncertainty. Findings also model a System of Illness Uncertainty that contends that women's experiences with illness uncertainty is an endless process that changes over time. In the System of Illness Uncertainty, women were Doubters, Resisters, Persisters, or Burnouts; all women experienced a paradigm shift regarding the Western health system as a result of their experiences. This research adds to the knowledge base on individuals who occupy spaces between the legitimized, diagnosable ill and the symptom-free healthy. Implications affect not only individuals and their families, but the politics of Western medical establishments. / Ph. D.

By listening to peoples' constructed stories of special places, the average person begins to understand why and how attachments to places form. This study concerns the attachments residents of Isle au Haut, Maine possess on the remote island, which borders part of Acadia National Park. The purpose of this study is to uncover social components of both place attachment and place identity among island residents as well as explain the process by which those residents form attachments. Twelve interviews were conducted both on Isle au Haut as well as nearby Mount Desert Island. Qualitative data were collected from a purposive sample of island residents and National Park Service employees who are responsible for managing the park on the island. In-depth interviews were the sole means of data collection and provided detailed stories of life on the island and attachments that have formed. This study uses grounded theory techniques in data analysis to ultimately form a theory grounded in the collected data. The findings from this study indicate that social interaction is key to residents forming an attachment to Isle au Haut. Further, three major social constructs emerged from the data analysis. Those constructs are sense of community, shared purpose, and shared history, all of which were found to contribute to place identity and place attachment among the residents. The results also suggest place identity as more salient than place dependence in residents' narratives concerning their attachment to the island. / Master of Science

Despite increased usage of online dating platforms, perceptions of meeting partners online remain generally stigmatized. When people internalize stigmatized online dating narratives as self-stigma, there are implications for psychological wellbeing and relational health. In the current study, through an open-ended online survey, I explored online dating narratives and perceptions of stigma in the experiences of 110 participants who met their partners online. I used thematic analysis (Braun and Clark, 2006) to identify and illustrate resulting themes, which revealed that (a) a general stigma about meeting partners online persists; (b) individuals are more likely to share that they met their partner online if they perceive their audience to be trustworthy; (c) intersections of race, ethnicity, gender, and sexual orientation influence how people share their online dating narratives; (d) a hierarchy of legitimacy exists amongst online dating platforms; and (e) the benefits of meeting online often outweigh the stigma. I used both symbolic interactionist and narrative therapy frameworks to explore the implications of these findings and make suggestions for marriage and family therapists (MFT) working with clients who met their partners online. As well, I proposed competencies in online relationships for MFT education. / Ph. D.

Over the last decades, imaging methods in animal models underwent revolutionary developments. Yet the potential of novel and accurate techniques for the imaging of neural substrates realizes fully only through interaction with human research and its system-level understanding of brain function. For instance, cross-species investigation is fundamental for auditory neuroscience, in particular in the study of sound source localization processing. The translation of auditory spatial cues into their neural representation has been addressed in multiple studies across species, allowing the development of theoretical and functional models of auditory space. However, auditory localization within the vertical plane remains less explored, with few animal studies addressing the neuroscience of elevation perception in the cortex. The study presented here aims to set the basis to bridge this knowledge gap, leveraging the interaction of human and animal neuroscience. Recent human studies identified an inverse linear relationship between sound source elevation and cortical activity and revealed remarkable plasticity in auditory cortical tuning for elevation. Building on these results, our laboratory conducted an Electroencephalography (EEG) experiment with human subjects. That study confirmed that sound source elevation is represented in a systematic manner in the human auditory cortex, but did not elucidate how the cortical substrate supports this representation. In fact, EEG lacks the spatial resolution to fully investigate the generators of the signals it measures, the circuital components of the auditory cortex. To bypass this challenge, we can assess if the same experimental protocol can yield similar results in a mouse model, the substrates of which can then be interrogated with molecular imaging tools. The results of such circuital dissection do not necessarily translate back to human research but can inform and guide its explorations provided solid theoretical basis and supporting computational models. Thus, in this dissertation we develop a comprehensive experimental platform for mouse EEG, aiming to translate protocols from human cognitive neuroscience to animal models. This translation, and its validation, lays the groundwork for further interrogation of the neural substrates of auditory perception and is the purpose of two experiments we present at the end of this thesis. We dedicate Chapter 1 to highlighting the necessity of integrating human and animal models to comprehend cortical functions and their implications for complex behavior. To further demonstrate the potential of this approach, in Chapter 2 we highlight the importance of omission responses, corollary discharge, and mismatch negativity (MMN) research from an interactionist standpoint, further showcasing how animal models can elucidate circuit-level substrates and contribute to multisensory integration theories. This investigation requires a deep understanding of spatial audition, and to this end in Chapter 3, we provide such detailed exploration, focusing on the auditory system's ability to localize sound within a three-dimensional space. In Chapter 4 we detail the modular setup for mouse EEG and imaging that we developed from scratch as part of this doctoral work. This setup is designed to facilitate the precise delivery of auditory stimuli and the accurate recording of EEG and optical imaging data under controlled conditions. The modular design philosophy centers on the integration of a robotic surgery station, anesthesia system, stimulus delivery system, optical imaging, and EEG systems in an integrated station, ensuring seamless transfer between different stations depending on the experiment requirements. We overview these components in the hardware section, which also describes the auditory stimulation system with its speaker arch that can be employed in a horizontal or vertical position. We also describe the surgical station, highlighting the modified stereotaxic apparatus and the surgical robot that allows for automated skull drilling and electrode array placement with micrometer-level precision. In the EEG systems section, we delineate the two types of EEG apparatus used in the experiments: subcutaneous needle electrodes (SNE) and multielectrode array (MEA). We discuss the advantages and drawbacks of SNE, the electrode positioning, and the importance of the reference and ground electrodes. We also describe the MEA system, emphasizing its high-density recordings and reduced movement artifacts. Finally, in the workflow section, we outline the sequence of operations for the experiments, from electrode implantation to processor initialization and stimulus presentation. We detail the electrode implantation procedures for both SNE and MEA, the initialization of processors and software for managing the EEG and stimulation systems, and the Python experimental platform that integrates all these components into a cohesive experimental protocol. We first employed this setup for the experiment detailed in Chapter 5 to explore the processing of sound source elevation in mice employing an adapter-probe paradigm. The aim was to assess whether it would yield comparable results to its application in humans. This paradigm is designed to induce short-term auditory adaptation, which leads to a decrease in neural responses to stimuli. By utilizing an adapter stimulus without local cues, we prevent suppression of location-specific processing, while silencing other sound-responsive neurons. We then present probe stimuli from different elevations, the responses to which should be dependent on the elevation modulation rather than the auditory processing suppressed by the adapter. This strategy allows us to record elevation-specific EEG activity with a better signal-to-noise ratio than would be otherwise possible. With this approach, we measured ERP components that align with those documented in humans, with a typical latency shift. Among these components, we identified a novel ERP correlate of sound source elevation processing in mice. This neural signature consists of a slow-rising mid-latency ERP component, which parallels the one elicited by the same protocol in humans. However, the effect of elevation was small, and limited to a contrast between the response to central stimuli and those above and below the animal. Our results reinforce the notion that mice ERPs can be used to investigate sound source elevation, highlighting similarities between human and mouse auditory processing. However, these conclusions hinge on an additional exploration into whether the auditory system of anesthetized mice can reliably produce responses specific to sound elevation. We address this critical aspect in the experiment presented in Chapter 6. In this second experiment, we employed a mismatch paradigm to discern whether anesthetized mice could differentiate between high and low sound sources. This involved alternating each sound source elevation as a deviant within a regular sequence of stimuli at the same elevation. We hypothesized that if the mice's auditory system could distinguish these elevations, we would observe an MMN effect, indicated by more negative responses to deviant stimuli compared to standard ones. This effect would be more pronounced for deviant stimuli from elevations further from the standard than for those closer. To enhance our experimental setup, we utilized a proprietary MEA for improved standardization and spatial resolution. With this setup we observed a biphasic MMN, with two distinct negative deflections, confirming the auditory system's capability to process stimuli from different elevations. This finding was intriguing, also considering the importance of head movements in auditory spatial perception, as discussed earlier. The biphasic nature of MMN might reflect different stages of cortical processing, with the late MMN suggesting complex spectral comparison as a possible analog of the human late discriminative negativity. We also found that deviant stimuli at -30 and 90° elevation did not elicit mismatch responses when presented in experimental blocks where the standard was at a 60° distance, but did when the standard was at a 120° distance. This finding confirmed our initial hypothesis However, our results also highlighted the unique status of the 30° elevation stimulus. In contrast to other elevations, the 30° stimulus showed a more pronounced early adaptation, and elicited a strong MMN as a deviant in the 60° proximity scenario. This suggests a possible bias in auditory processing towards this elevation range, potentially influenced by top-down modulation. The distinct adaptation behavior of the 30° stimulus could be a consequence of such modulation, aligning with behavioral studies and electrophysiological findings in other species. Further, we proposed a model where MMN elicitation in mice depends on the proximity of the deviant to a preferred elevation angle, near 30°, and the distance of the standard from the deviant. Such model could capture the dynamics of elevation representation mismatch. To explore these effects, further experiments with additional conditions are needed, potentially leading to a quantitative model of elevation deviance. Finally, in Chapter 7 we further explore possible research directions that could follow the work presented here, beyond what was already introduced in the experimental chapters